Lean Six Sigma Project - To Improve Accuracy and Efficiency in Booking & Information Enquiries in the Radiology Department Poster No.:
C-0027
Congress:
ECR 2011
Type:
Scientific Exhibit
Authors:
R. LEE, G. Lo, M. L. Hung, S. M. Lau, K. M. Chan; Hong Kong/CN
Keywords:
lean, six sigma
Keywords:
Management, Computer applications
DOI:
10.1594/ecr2011/C-0027
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Purpose Department of Diagnostic and Interventional Radiology (Figure 1 on page 2) is one of the largest and most contributing departments in Hong Kong Sanatorium & Hospital. With a staff of 40 radiographers, 9 radiologists, 5 nurses and 6 receptionists, this Department provides more than 200 examinations and interventional procedures. There were about 68,000 cases performed in 2008 (~250 cases/day) The department received complaints from doctors, patients and other staffs regarding on the clumsy booking procedure, training of clerk to understand medical terms and price quoting which led to dissatisfaction of relevant patients and staff. Lean Six Sigma team was formed to improve the booking procedure and information enquiry process by applying Lean Six Sigma principles. Images for this section:
Fig. 1
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Methods and Materials By means of Lean Six Sigma methodology, through the data driven DMAIC (Define, Measure, Analysis, Improve & Control) framework. Define stage: The team began the define stage by brainstorming and distributing questionnaires to the frontline staff. 55 questionnaires were distributed and received. Major dissatisfactions of our staff in booking were (Figure 1 on page 5): 1. 2. 3. 4.
Searching the price list (42%) Price list clarification (32%) IT application (26%) Search information (26%)
Our internal customers would like to finish a booking within 3 minutes In order to better understand the current situation such as voice of customers, and interpret the process being studied, we further analyzed the booking procedure through customer requirement tree (Figure 2 on page 6), process flow chart (Figure 3 on page 7), cause and effect matrix, and SIPOC chart (Figure 4 on page 8). From the above figures, we found that timeliness and accuracy were the critical requirements from the customers' perspective. Moreover promptly information searched and delivered by clerks were also very significant in the whole process input.
Measurement stage During the measurement phase, the team started to plan collecting relevant data on the various quantitative data in booking procedure. A measurement plan was developed to understand the existing Sigma level & capability. 10 frontline staff were selected, the following measurements were taken (Figure 5 on page 9): - Time to search the price
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- Time to search the preparation form - Time to prepare preparation form - Time to send preparation to ward Data were collected by following the above plan. It was found out that in median time, it took 30s to search examination charge from a file, 15 seconds to go to search a preparation form from a tray, 35 seconds to write up a preparation form and 40 seconds to use a fax machine to fax the preparation form to ward. The median time to complete the above booking procedures took 137 seconds (Figure 6 on page 10). From the Boxplot (Figure 6 on page 10) and I-MR charts (Figure 7 on page 10), we found that the process of searching price and sending form to ward were longest in time duration (mean = 41.2s & 41.8s) and highest variation (sd 8.9s). The process capability was considered dissatisfactory since some of the data collected was beyond customer's specification limit (3 minutes). According to the calculation of the capability indices, the Cpk was 0.4 and the sigma level was 1.2 which is not satisfactory. From measurement stage, the team had a better understanding of the great variation range of the current situation and how likely our customers' expectations were being met.
Analysis stage The first step of the analysis stage was to review all the diagrams like cause & effect matrix, SIPOC and process flow chart (figure 2-4) to identify the potential and key problems within the process. Process Failure Mode and Effect Analysis (FMEA) (Figure 8 on page 11) analytical tool had been selected for identifying the potential failures within the process. Afterwards, appropriate actions could be recognized to eliminate or reduce the occurrence of potential failures. In FMEA, we found that wrong information given to patients would have largest impact to the whole procedure. We also interpreted the real situation that to find a specific examination in a big file was a clumsy procedure. Moreover, finding a specific preparation form from a multi-layers drawer was non-value added. In addition, sending a preparation form needed to walk through a long corridor to reach the fax machine was also a non-value added process.
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Improve stage Based on the findings from define and measurement stages, some of the improvements are suggested and done. Mainly target on the searching process, sending process and training of staff. After the analysis stage, some action for improvement were done as follows: 1.
2.
3.
Develop a program with Graphic User Interface (GUI) to search any examination (out of >200 items) within 10 seconds (Figure 9 on page 12). By using this program, the charge and preparation procedures can be found promptly and accurately Develop an online multimedia education program for front desk staff to enhance their understanding in each modality (MRI, CT, US) Figure 10 on page 13. By using the multimedia educational program, our new staff can learn all the medical terms no matter in working place or at home. Moreover, it does not depend on the availability of mentors (who is always busy) Enhance & simplify searching process of preparation form by using electronic form (e-form) Figure 11 on page 14
There are several advantages by using e-form such as: • • •
Prevent reading errors as it is much clearer (digital) Shorten the whole process (cycle time) of form filling and sending Reduce waste (time to scan, extra-print outs, extra paper)
Control stage To guarantee performance: • Setting up instruction guidelines and user manuals • Continuous monitoring data over 3 months • Obtaining feedback every month • Continuously updating & refining the program Images for this section:
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Results Two weeks after the implementation of the above changes, the booking process was remeasure as in measurement stage, the results were summarized as follows (Figure 1 on page 16 & Figure 2 on page 16): 1. 2. 3. 4. 5. 6. 7.
There was markedly improvement in searching price and preparation procedure for each examination from 30s to 8s (median time) There was markedly improvement in searching preparation form from 15s to 3s There was significant improvement in send form to wards from 40s to 12s. Variation in whole process has been reduced. (SD: 32.6s to 8.1s) Overall median time was reduced from 137 to 59.5s Cpk was increased from 0.4 to 1.33 Sigma level increased from 1.2 to 3.99
Images for this section:
Fig. 1
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Conclusion By using Lean 6 Sigma tool: 1. 2. 3. 4. 5. 6. 7.
Increase speed & reduce variations in information enquiry process (e.g. price quotation) More efficient way with higher quality in sending preparation forms Reduce inventory (less space required to store forms) Multiple terminals (computers) are available (7 computers for send form, 7 computers to search information) More effective way of training new clerks (e.g. multimedia program & data organization) Save ~75s for each case of registration About 68,000 cases in 2008, so we can save about 85,000 minutes (1400 hour) per year (~$10,000/month)
References 1.
2. 3.
Michael L. George (2003). Lean Six Sigma for Service : How to Use Lean Speed and Six Sigma Quality to Improve Services and Transactions. USA: McGraw-Hill. Stephen A. Zinkgraf (2006). Six Sigma - The Frst 90 Days. USA: Prentice Hall. Warren Brussee (2004) . Statistics for 6 Sigma Made Easy. USA: McGrawHill.
Personal Information Raymond Lee Department of Diagnostic & Interventional Radiology Hong Kong Sanatorium & Hospital Email:
[email protected]
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